Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. The purpose of this study was to gain a more thorough understanding of the interrelationships among the three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. Cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia was analyzed. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.
Parcesepe A, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, and Nash D. HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia. AIDS Behav. 2018 Feb 16. doi: 10.1007/s10461-018-2059-8. Link to PubMed >>